[Clinical study of the impact of a history of chronic diseases on the mortality of patients with multiple organ dysfunction syndrome in the elderly].

OBJECTIVE: To analyze the clinical feature of multiple organ dysfunction syndrome in the elderly (MODSE) and study the impact of a history of chronic diseases on the mortality of patients with MODSE. METHODS: Altogether 331 cases with MODSE were prospectively analyzed in 4 tertiary-level teaching hospitals in Beijing and Tianjin cities from March 2002 to January 2005. RESULTS: In our investigation,the primary etiology of MODSE was severe infection (27.2%), shock (24.5%), major operation (22.1%), cardiopulmonary resuscitation (CPR) (11.2%), severe trauma (7.2%), or severe pancreatitis (6.6%) in order of frequency. The incidence rate of dysfunction in cardiovascular system, lung, brain, gastrointestinal system, kidney, coagulation system and liver was 72.2%, 94.6%, 74.6%, 83.1%, 77.9%, 76.1%, 77.6% respectively. The mortality rates in the group with dysfunction of lung, brain, cardiovascular and gastrointestinal system were higher than those with the normal organ function. The mortality rate of patients with brain dysfunction ranked the highest (74.1%). Seventy-eight point five percent of patients with MODSE had a history of chronic diseases, and in average with two chronic diseases. The mortality rate of patients with chronic diseases was higher than those without chronic diseases (68.1% vs. 54.9%, P=0.039). With the increase in number of failing organs, mortality was getting higher. CONCLUSION: Infection is the most common primary cause, lung and gastrointestinal system are the most affected organs in multiple organ dysfunction, and the mortality rate of patients with brain dysfunction is the highest. The mortality rate of patients with chronic diseases is higher than those without chronic diseases. Early intervention of primary diseases and chronic diseases and prompt control of infection play a key role in preventing deterioration of patients with MODSE.

[Clinical observation on 25 cases of severe angiostrongyliasis cantonensis].

OBJECTIVE: To summarize the clinical features of severe angiostrongyliasis cantonensis (AC) patients. METHODS: Clinical data on symptoms, physical signs, auxiliary examination and prognosis of 25 severe AC patients hospitalized in June-Sept 2006 were analyzed. RESULTS: Epidemiologically, all cases had eaten uncooked fresh water snails. One of the early symptoms was fever (16 cases, 64.0%), including 8 cases with low-grade fever, 7 cases with mid-range fever, and 1 case high fever. Nervous system manifestation: (1) All cases had headache, entire headache (56.0%) or partial (44.0%), especially in occipitalis. (2) Patients had distinct degree neck rigidity, with negative pathologic reflex; 12 cases had nausea and vomiting (48.0%). (3) 20 cases (80.0%) had skin paresthesia, 5 had severe pain and hyperalgia on skin; 3 cases with skin numbness, and 2 with thermohypesthesia. (4) 11 cases (44.0%) appear distinct degree depraved vision; 3 cases had photophobia, 5 with blur vision, 1 each with diplopia, defect of field vision or bug sign, respectively. (5) Nasolabial groove became shallow and distortion of commissure in 4 cases (16.0%), and 2 cases (8.0%) couldn't close up eyelid. (6) 4 cases had sustained or curative tinnitus. Laboratory examination showed that eosinophilic granulocytes increased in both peripheral blood and cerebrospinal fluid. Skull MRI for 14 cases revealed linear enhancement in local meninx or abnormal enhancement in cerebral parenchyma. Chest CT examination in 7 cases showed nodule shadow and spot flaky ground-glass shadow in lungs. One and 3 months after being discharged from hospital, 12 patients (48.0%) still had sequelaes--7 cases had tingling sensation on skin, 1 case had temperature sensation dysfunction on the skin of chest and abdomen, 3 cases had headache occasionally, and 1 case still had defect of field vision. CONCLUSION: Central nervous system has been impaired in the angiostrongyliasis cantonensis patients who may need a longer convalescent period.

A scoring system for assessing the severity of acute diarrhea of adult patients.

BACKGROUND: Diarrhea is frequently seen in developed and developing countries, and severe diarrhea is characterized by the high risk of death. Thus, it is very important to assess the severity of diarrhea early. We conducted a multi-center study to identify risk factors for the severity of diarrhea in adult patients and formulate an adult diarrhea state score (ADSS) for out-patient clinicians. METHODS: A total of 219 adult patients with acute diarrhea were divided into two groups: 132 patients with mild diarrhea and 87 with severe diarrhea. Logistic regression was used to determine risk factors for the severity of diarrhea. The risk factors were assessed and an ADSS was formulated. Receiver operating characteristic (ROC) analysis was made to evaluate the diagnostic accuracy of ADSS, and the Kappa test was used to confirm the diagnostic reliability. RESULTS: Five risk factors for evaluating the severity of diarrhea in adults included age (P<0.05), axillary temperature (P<0.01), mean arterial pressure (P<0.01), white blood cell count (WBC; P<0.01), and WBC in stool (P<0.01). The area under the ROC curve for ADSS was 0.958 when the cut off value was 4 (a sensitivity of 0.909; a specificity of 0.874), and the Kappa value was 0.781 (P<0.05). CONCLUSION: The risk factors associated with the pathogenic condition of diarrhea were identified, quantified and formulated into an ADSS, which has high diagnostic accuracy and reliability for the early identification of patients with severe acute diarrhea.

[Epidemiological analysis on 141 cases of angiostrongyliasis cantonensis in Beijing].

OBJECTIVE: To provide scientific basis for angiostrongyliasis cantonensis control and prevention in Beijing. METHODS: Descriptive epidemiological method was used to analyze angiostrongyliasis cantonensis reported from June to September in 2006. RESULTS: 141 cases were treated at the Beijing Friendship Hospital with the peak in July (61 cases) and August (68 cases). All patients had dined at the same restaurant in Beijing city and they ate undercooked Pomacea canaliculata or related eatables. The source of Pomacea canaliculata was from Guilin in Guangxi. Major manifestations would include fever (56.79%), headache (93.83%), neck stiffness (100%), and skin paresthesia (77.78%). Some cases had significant eosinophil increase in peripheral blood picture and cerebrospinal fluid respectively. CONCLUSION: The source of infection related to angiostrongyliasis cantonensis was clear, suggesting that the improvement of restaurant sanitation and on awareness of personal hygiene were important preventive and control measures on angiostrongyliasis cantonensis.